Commentary

Docs assess Melo's shoulder injury

Three medical experts answer questions about Carmelo Anthony's rehab decision

Updated: October 23, 2013, 12:34 AM ET
By Ian Begley | ESPNNewYork.com

Carmelo AnthonyJim Davis/The Boston Globe/Getty ImagesIs Carmelo Anthony's shoulder at greater risk for re-injury this season?
Literally and figuratively, the Knicks' 2013-14 season rests on Carmelo Anthony's shoulders.

But are they healthy enough to carry the load?

Anthony suffered a labrum and rotator cuff tear in his left shoulder late last season. He played through the injury in the playoffs and underwent an intense rehab in the offseason.

The decision was viewed by some as a risky one.

Carmelo Anthony
Nathaniel S. Butler/Getty ImagesDecrease in range of motion is one of the possibilities surgery presented to Anthony's shoulder.

Anthony could have gone under the knife to fix the tears in his shoulder, but surgery would have sidelined him for a portion of the regular season.

Earlier this month, Anthony acknowledged that he took a "huge risk" by deciding against the procedure. He's also said several times over the past few weeks that his shoulder feels fully healthy.

"I'm ecstatic going from a torn rotator cuff and torn labrum to not needing surgery," Anthony said. "Let me take that back: Taking a risk in not taking surgery and letting it heal on its own. I took a huge risk in doing that. It meant I had to put more time in the offseason to do what I had to do to get it right."

Anthony has looked healthy through the Knicks' first five preseason games. But the state of his shoulder will be closely monitored throughout the season.

With that in mind, we asked three shoulder experts to answer a few pertinent questions about Anthony's decision to rehab instead of having surgery.

HOW DOES A LABRUM AND ROTATOR CUFF TEAR AFFECT A SHOULDER?

The labrum provides stability to your shoulder, according to ESPN injury expert Stephania Bell.

What we saw in the playoffs, that type of pattern, could occur more frequently over the course of the season.

-- Orthopedic surgeon Dr. Neil Roth on Anthony's shoulder popping in and out

So any damage to the labrum can affect the stability of the shoulder, Bell says.

That's why Anthony said during the playoffs that his shoulder "popped in and out," according to Dr. Neil Roth, an orthopedic surgeon specializing in sports medicine and the attending physician at Lenox Hill Hospital.

"What we saw in the playoffs, that type of pattern, could occur more frequently over the course of the season," Roth says.

That all depends on the type of contact Anthony meets, and how well he rehabbed the injury over the summer.

WHY NOT JUST HAVE SURGERY?

If Anthony had opted for surgery, couldn't he have returned to the court with his shoulder in the same condition it was before the injury?

Not necessarily.

There are plenty of risks involved with shoulder surgery, the experts say.

If Anthony had opted for surgery, he might have lost some range of motion in his shoulder.

"That would definitely be something to take into account," says Dr. Gregory Galano, an orthopedic surgeon who specializes in shoulders at Lenox Hill. "It isn't really something that comes into play if he just goes through rehab. You're not really going to lose any motion typically."

That limited range of motion might have thrown off Anthony's shooting mechanics or his ability to dribble.

"That little bit of motion that they lose could be the difference in their ability to perform at the level that they're performing," Roth says.

Adds Bell: "You just don't know what the outcome [of surgery] is going to be, there's a lot of uncertainty."

Surgery also would have forced Anthony to miss a portion of the season.

HOW CAN REHAB HELP THE SHOULDER?

Anthony's rehab likely included the strengthening of muscles surrounding the shoulder, such as those in the upper back and shoulder blade, and the shoulder muscles themselves.

"The shoulder blade muscles set the platform for the rotator cuff muscles to perform their function. When they're working in unison and are rehabbed properly, you have a good functioning shoulder joint," Roth says.

Bell, a board-certified orthopedic clinical specialist and strength and conditioning specialist, notes that rehab, when done correctly, can strengthen shoulder muscles or muscles surrounding the shoulder that may have been weak prior to the injury.

"We often find that athletes have these weaknesses that they may have had or have been developing for a long period of time, so [with rehab] they build up all these muscles that they haven't used for years," Bell says.

That could be why Anthony says he feels great following the intensive offseason rehab.

IS THE SHOULDER AT A GREATER RISK FOR RE-INJURY THIS SEASON?

MeloTom Szczerbowski/USA TODAY SportsIt's too early to determine whether rehab was the proper course of action to take.

Rehab won't fully heal the tears in Anthony's shoulder, the experts say.

"A labrum tear doesn't heal itself," Bell says. "Once you have damage, [the shoulder after rehabilitation is] not going to be as good as the original structure. [Anthony] can rehab all he wants and that labrum will [still] have damage to it; that doesn't change. But functionally, he should be fine."

Galano notes that there is "a small chance" the tears in Anthony's shoulder will get worse during the season.

"But if he's able to play at a high level then ... I wouldn't even really put all the stock in that," Galano says. "I would put more stock in what he's able to do on the court and whether he's in pain when he does it."

It's worth noting, however, that Anthony is at risk of re-injury if he gets hit the wrong way. Galano believes Anthony's risk of injury is "not that much significantly higher that anyone else playing the game."

"He might go on a couple more seasons and not have an issue with it," Bell says. "He could also have an issue very quickly. This is sort of the big unknown. If he gets jammed, somebody hits it just right, [or] it gets yanked in a way that stretches that tissue or creates inflammation, that could effect how everything is working. Any of those things can happen and it could flare up."

DID ANTHONY MAKE THE RIGHT CALL?

That's almost impossible to determine right now.

But the experts believe Anthony chose the best course of action when he decided to rehab the injury.

Bell If you're in the wrong position and your shoulder gets jammed, everyone's going to come out of the woodwork and say, 'See he should have had surgery.'

-- Stephania Bell on possible repercussions from re-injury

It needs to be noted that none of them have treated Anthony or viewed his MRIs, nor are they questioning the diagnosis prescribed by the Knicks medical staff, they say.

"I think it's perfectly reasonable [to opt for rehab] as long as he's not limited or symptomatic to the degree that he's not able to do what he needs to do on the court," Galano says. "Right now, it seems like he's able to play at the level that he needs to play at and he's not overly symptomatic as a result of it. So I would say right now that it was the right call."

But Bell notes that these things can be "situational." If Anthony's shoulder is caught in the wrong position, he could suffer re-injury and open himself and the Knicks to second-guessing.

"If you're in the wrong position and your shoulder gets jammed, everyone's going to come out of the woodwork and say, 'See he should have had surgery,'" she says, though she wouldn't agree with that reaction.

"A conservative approach is often a good first choice," Bell adds. "If it works, great. Even if the athlete needs surgery down the line, the strengthening will still have been beneficial because it will improve the process post-surgery."

Maybe Roth summarizes the situation best.

"It's always a difficult call as to what the right treatment is for a professional athlete," he says. "You're dealing with, No. 1, their livelihood, and No. 2, their ability to perform at the level they need to perform. Melo may have absolutely made the right call for himself; only time will tell."

You can follow Ian Begley on Twitter.

Comments

Use a Facebook account to add a comment, subject to Facebook's Terms of Service and Privacy Policy. Your Facebook name, photo & other personal information you make public on Facebook will appear with your comment, and may be used on ESPN's media platforms. Learn more.


EDITORS' PICKS

  • Bear Hugged
    Mistakes, plus not enough breaks, befuddled Geno Smith and the Jets.
  • Pineda Puts Up O's
    Michael Pineda went 7 1/3 giving up just a hit, a walk and no runs vs. the O's.
  • Sudden Comfort
    Eli Manning is beginning to get cozy -- and thrive -- in the Giants' new offense.
  • Extension In The Works
    The Mets are negotiating a new multiyear extension for Sandy Alderson.
  • The Jeter Nobody Knows
    Derek Jeter welcomed fans into his world and revealed he's not who you think.